| NPI | 1396934113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: TX N2765) |
| Additional Taxonomies | 208600000X Surgery (Licence: MI 5101015953) |
| Enumeration Date | 2007-10-17 |
| Last Update Date | 2019-06-25 |